- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $5,888.44 / $14,791.08
| Facility | | $1,288.25 | $5,888.44 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $4,168.69 / $6,760.83
| Professional | | $1,288.25 | $4,168.69 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,748.98 / $14,791.08 / $15,848.93
| Facility | | $11,748.98 | $14,791.08 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,122.02 / $1,621.81
| Professional | | $851.14 | $1,122.02 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $2,630.27 / $3,548.13
| Professional | | $776.25 | $2,630.27 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,235.94 / $3,890.45 / $4,786.30
| Professional | | $3,235.94 | $3,890.45 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $2,344.23 / $11,481.54
| Facility | | $1,288.25 | $2,344.23 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $5,495.41 / $28,183.83
| Facility | | $1,348.96 | $5,495.41 | $28,183.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $5,495.41 / $28,183.83
| Professional | | $1,348.96 | $5,495.41 | $28,183.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,964.78 / $18,620.87 / $40,738.03
| Facility | | $10,964.78 | $18,620.87 | $40,738.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,318.26 / $2,630.27
| Professional | | $812.83 | $1,318.26 | $2,630.27 |